Sentences Are Key: Helping School-Age Children and Adolescents Build Sentence Skills Needed for Real Language.

PURPOSE: In this article, we present key concepts pointing to the importance of targeting complex sentences for school-age children and adolescents with developmental language disorders (DLD). Drawing on current treatment research, we argue that the sentence is a crucial but often neglected piece of the puzzle when it comes to understanding relationships between DLD and academic outcomes. We provide detailed suggestions for how clinicians can focus on complex sentence structures in natural academic contexts to bridge this gap. METHOD: Background information on sentence complexity is presented, along with a rationale for targeting complex sentences with school-age children and adolescents with DLD. Intervention methods from a variety of studies targeting multiclausal sentences are discussed in relation to current accounts of language learning and language processing models. We provide a robust catalog of suggested strategies for targeting sentence complexity in a manner that is aligned with research findings to date and integrated into real academic contexts. CONCLUSIONS: Complex sentence structures are a key challenge for students with DLD as they tackle discipline-specific language and academic tasks. Sentence complexity treatment programs employ one or more treatment methods including priming, modeling, recasting, contextualization, metalinguistic instruction, and sentence combining. While studies have consistently shown a measurable improvement in complex sentence production on proximal outcomes regardless of treatment approach, evidence of durable, functional changes for students with DLD remains sparse. We encourage new treatments that target comprehension and production of complex sentences in real-life academic contexts in clinical practice and research. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23969103.

How Different Pre-existing Mental Disorders and Their Co-occurrence Affects COVID-19 Clinical Outcomes? A Real-World Data Study in the Southern United States.

Background: Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. Methods: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients' healthcare utilization data via ICD-10 codes. Results: There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic and comorbidity covariates. Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 1.26 (95% CI: 1.151, 1.383) for patients with internalizing and externalizing disorders, 1.65 (95% CI: 1.298, 2.092) for internalizing and thought disorders, 1.76 (95% CI: 1.217, 2.542) for externalizing and thought disorders, and 1.64 (95% CI: 1.274, 2.118) for three clusters of mental disorders. Conclusions: Pre-existing internalizing disorders and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster.

Demographic Disparities in Clinical Outcomes of COVID-19: Data From a Statewide Cohort in South Carolina.

BACKGROUND: Current literature examining the clinical characteristics of coronavirus disease 2019 (COVID-19) patients under-represent COVID-19 cases who were either asymptomatic or had mild symptoms. METHODS: We analyzed statewide data from 280 177 COVID-19 cases from various health care facilities during March 4-December 31, 2020. Each COVID-19 case was reported using the standardized Case Report Form (CRF), which collected information on demographic characteristics, symptoms, hospitalization, and death. We used multivariable logistic regression to analyze the associations between sociodemographics and disease severity, hospitalization, and mortality. RESULTS: Among a total of 280 177 COVID-19 cases, 5.2% (14 451) were hospitalized and 1.9% (5308) died. Older adults, males, and Black individuals had higher odds of hospitalization and death from COVID-19 (all P < 0.0001). In particular, individuals residing in rural areas experienced a high risk of death (odds ratio [OR], 1.16; 95% CI, 1.08-1.25). Regarding disease severity, older adults (OR, 1.06; 95% CI, 1.03-1.10) and Hispanic or Latino patients (OR, 2.06; 95% CI, 1.95-2.18) had higher odds of experiencing moderate/severe symptoms, while male and Asian patients, compared with White patients, had lower odds of experiencing moderate/severe symptoms. CONCLUSIONS: As the first statewide population-based study using data from multiple health care systems with a long follow-up period in the United States, we provide a more generalizable picture of COVID-19 symptoms and clinical outcomes. The findings from this study reinforce the fact that rural residence and racial/ethnic social determinants of health, unfortunately, remain predictors of adverse health outcomes for COVID-19 patients.

Co-design of an oral health promotion animated film with families in the South of England.

Introduction Oral health promotion interventions should be evidence-based and designed with community involvement. In England, Family Hubs are attended by families from a range of social backgrounds and provide an ideal setting for co-design of health interventions.Aim To co-design and evaluate an animated film for promoting oral health in community settings.Methods Families attended two co-design workshops at a Family Hub in Portsmouth, during which they discussed oral health priorities and commented on the animation design. A before-and-after survey questionnaire assessed its impact on oral health knowledge in another Family Hub in Portsmouth. Qualitative data were analysed using the Framework method, while the survey data were analysed descriptively.Results Families prioritised evidence-based advice for inclusion in the film and contributed to the film storyline. This enabled relevant alterations to ensure the animation was engaging and age-appropriate. Although the survey response rate was low for inferential statistics, descriptive analysis indicated variation in the oral health knowledge of parents and carers.Conclusion Families can offer valuable contributions to the design of health promotion interventions. A co-design method provides an approach for communicating health advice in a form that is relevant and applicable to target audiences.

An In-Depth Analysis of Expository Writing in Children With and Without Autism Spectrum Disorder.

Using detailed linguistic analysis, this study examined the expository writing abilities of school-age children with autism spectrum disorder (ASD) in comparison to neurotypical (NT) children. Associations between executive functioning (EF) and writing ability in children with and without ASD were also explored. Compared to NT peers, children with ASD wrote shorter expository texts that contained more grammatical errors, and needed more assistance from the experimenter to complete the writing assessment. However, the texts of children with and without ASD did not differ in their lexical diversity, use of writing conventions, and overall quality. Analyses also revealed that greater EF was associated with better writing outcomes in both groups. Educational implications of these findings are discussed.

Targeting Complex Sentences in Older School Children With Specific Language Impairment: Results From an Early-Phase Treatment Study.

Purpose: This study investigated the effects of a complex sentence treatment at 2 dosage levels on language performance of 30 school-age children ages 10-14 years with specific language impairment. Method: Three types of complex sentences (adverbial, object complement, relative) were taught in sequence in once or twice weekly dosage conditions. Outcome measures included sentence probes administered at baseline, treatment, and posttreatment phases and comparisons of pre-post performance on oral and written language tests and tasks. Relationships between pretest variables and treatment outcomes were also explored. Results: Treatment was effective at improving performance on the sentence probes for the majority of participants; however, results differed by sentence type, with the largest effect sizes for adverbial and relative clauses. Significant and clinically meaningful pre-post treatment gains were found on a comprehensive oral language test, but not on reading and writing measures. There was no treatment advantage for the higher dosage group. Several significant correlations indicated a relationship between lower pretest scores and higher outcome measures. Conclusions: Results suggest that a focused intervention can produce improvements in complex sentence productions of older school children with language impairment. Future research should explore ways to maximize gains and extend impact to natural language contexts. Supplemental Material: https://doi.org/10.23641/asha.5923318.

A systematic evaluation of the potential effects of trichloroethylene exposure on cardiac development.

The 2011 EPA trichloroethylene (TCE) IRIS assessment, used developmental cardiac defects from a controversial drinking water study in rats (Johnson et al. [51]), along with several other studies/endpoints to derive reference values. An updated literature search of TCE-related developmental cardiac defects was conducted. Study quality, strengths, and limitations were assessed. A putative adverse outcome pathway (AOP) construct was developed to explore key events for the most commonly observed cardiac dysmorphologies, particularly those involved with epithelial-mesenchymal transition (EMT) of endothelial origin (EndMT); several candidate pathways were identified. A hypothesis-driven weight-of-evidence analysis of epidemiological, toxicological, in vitro, in ovo, and mechanistic/AOP data concluded that TCE has the potential to cause cardiac defects in humans when exposure occurs at sufficient doses during a sensitive window of fetal development. The study by Johnson et al. [51] was reaffirmed as suitable for hazard characterization and reference value derivation, though acknowledging study limitations and uncertainties.

Bringing the Simple View of Reading to the clinic: Relationships between oral and written language skills in a clinical sample.

PURPOSE: The Simple View of Reading (SVR) predicts subtypes of reading disorder based on weaknesses in word recognition, listening comprehension, or both. This practice-based research study explores predictions of the SVR within a clinical practice setting. METHOD: The study is a retrospective analysis of 112 assessment records from school-aged children (aged 6.0-16.7) referred for speech-language evaluation. Available scores within four areas (listening comprehension, word recognition, reading comprehension, and oral expression) were extracted and then converted to composites. Composite scores were used to categorize children into SVR subtypes. We examined the distribution of children across subtypes and the relationships among the four constructs. RESULTS: Children were distributed across all SVR subtypes, but few had impairments only in word recognition. Children with impairments in listening comprehension or word recognition showed poorer reading comprehension than those that did not, but there was imperfect prediction of reading comprehension impairment at an individual level. There were more significant correlations among constructs for younger children. Oral expression and listening comprehension were closely related across analyses. CONCLUSIONS: The SVR is a clinically useful model for capturing variation and explaining relationships among oral and written language in school-age children.

Exploring metagenomics in the laboratory of an introductory biology course.

Four laboratory modules were designed for introductory biology students to explore the field of metagenomics. Students collected microbes from environmental samples, extracted the DNA, and amplified 16S rRNA gene sequences using polymerase chain reaction (PCR). Students designed functional metagenomics screens to determine and compare antibiotic resistance profiles among the samples. Bioinformatics tools were used to generate and interpret phylogenetic trees and identify homologous genes. A pretest and posttest were used to assess learning gains, and the results indicated that these modules increased student performance by an average of 22%. Here we describe ways to engage students in metagenomics-related research and provide readers with ideas for how they can start developing metagenomics exercises for their own classrooms.

Relationships between narrative language samples and norm-referenced test scores in language assessments of school-age children.

PURPOSE: Both narrative language samples and norm-referenced language tests can be important components of language assessment for school-age children. The present study explored the relationship between these 2 tools within a group of children referred for language assessment. METHOD: The study is a retrospective analysis of clinical records from 73 school-age children. Participants had completed an oral narrative language sample and at least one norm-referenced language test. Correlations between microstructural language sample measures and norm-referenced test scores were compared for younger (6- to 8-year-old) and older (9- to 12-year-old) children. Contingency tables were constructed to compare the 2 types of tools, at 2 different cutpoints, in terms of which children were identified as having a language disorder. RESULTS: Correlations between narrative language sample measures and norm-referenced tests were stronger for the younger group than the older group. Within the younger group, the level of language assessed by each measure contributed to associations among measures. Contingency analyses revealed moderate overlap in the children identified by each tool, with agreement affected by the cutpoint used. CONCLUSIONS: Narrative language samples may complement norm-referenced tests well, but age combined with narrative task can be expected to influence the nature of the relationship.

One size does not fit all: improving clinical practice in older children and adolescents with language and learning disorders.

PURPOSE: In the lead article for this clinical forum, Kamhi (2014) suggests ways that current knowledge on instructional practices in learning and language can be applied to clinical practice in language disorders. I propose that Kamhi's suggestions are in need of fine-tuning for older children and adolescents with language disorders. A one-size-fits-all approach to language intervention across a broad age range is untenable due to unique needs and capabilities of this older population. METHOD: Three intervention goal priorities for older students are presented with supporting research: complex (multiclausal) sentences, verb structure, and expository text. Methodologies for teaching complex sentences are discussed next, including topics of content/form balance and treatment intensity. These goals and methods are designed to assist students with language disorders in the comprehension and production of complex language they encounter in school. CONCLUSION: Guidance for high-priority language intervention goals with older students comes from a consideration of language needs in academic settings and language weaknesses that persist in this population. Although current research offers support for these goals, less is known about methodological variables such as treatment intensity.

Human health effects of tetrachloroethylene: key findings and scientific issues.

BACKGROUND: The U.S. Environmental Protection Agency (EPA) completed a toxicological review of tetrachloroethylene (perchloroethylene, PCE) in February 2012 in support of the Integrated Risk Information System (IRIS). OBJECTIVES: We reviewed key findings and scientific issues regarding the human health effects of PCE described in the U.S. EPA's Toxicological Review of Tetrachloroethylene (Perchloroethylene). METHODS: The updated assessment of PCE synthesized and characterized a substantial database of epidemiological, experimental animal, and mechanistic studies. Key scientific issues were addressed through modeling of PCE toxicokinetics, synthesis of evidence from neurological studies, and analyses of toxicokinetic, mechanistic, and other factors (tumor latency, severity, and background rate) in interpreting experimental animal cancer findings. Considerations in evaluating epidemiological studies included the quality (e.g., specificity) of the exposure assessment methods and other essential design features, and the potential for alternative explanations for observed associations (e.g., bias or confounding). DISCUSSION: Toxicokinetic modeling aided in characterizing the complex metabolism and multiple metabolites that contribute to PCE toxicity. The exposure assessment approach-a key evaluation factor for epidemiological studies of bladder cancer, non-Hodgkin lymphoma, and multiple myeloma-provided suggestive evidence of carcinogenicity. Bioassay data provided conclusive evidence of carcinogenicity in experimental animals. Neurotoxicity was identified as a sensitive noncancer health effect, occurring at low exposures: a conclusion supported by multiple studies. Evidence was integrated from human, experimental animal, and mechanistic data sets in assessing adverse health effects of PCE. CONCLUSIONS: PCE is likely to be carcinogenic to humans. Neurotoxicity is a sensitive adverse health effect of PCE.

O-GlcNAc modification of the coat protein of the potyvirus Plum pox virus enhances viral infection.

O-GlcNAcylation is a dynamic protein modification which has been studied mainly in metazoans. We reported previously that an Arabidopsis thaliana O-GlcNAc transferase modifies at least two threonine residues of the Plum pox virus (PPV) capsid protein (CP). Now, six additional residues were shown to be involved in O-GlcNAc modification of PPV CP. CP O-GlcNAcylation was abolished in the PPV CP7-T/A mutant, in which seven threonines were mutated. PPV CP7-T/A infected Nicotiana clevelandii, Nicotiana benthamiana, and Prunus persica without noticeable defects. However, defects in infection of A. thaliana were readily apparent. In mixed infections of wild-type arabidopsis, the CP7-T/A mutant was outcompeted by wild-type virus. These results indicate that CP O-GlcNAcylation has a major role in the infection process. O-GlcNAc modification may have a role in virion assembly and/or stability as the CP of PPV CP7-T/A was more sensitive to protease digestion than that of the wild-type virus.

Development of the breast milk expression experience measure.

Exclusive breastfeeding provides optimal nutrition through 6 months. Recent research has shown that milk expression may affect breastfeeding duration. A woman's experience with milk expression might mediate the effect of milk expression on breastfeeding duration. The objective of this study was to develop a measure to evaluate women's experiences of expressing milk. Based on the available literature, we developed a brief measure of the Breast Milk Expression Experience (BMEE) assessing three dimensions: (1) social support for milk expression; (2) ease of learning how to express milk; and (3) personal experiences of milk expression. All items used 1-5 Likert scales, with higher scores indicating better experiences. We administered the items immediately after expression to 68 mothers who expressed milk post-partum. We evaluated this measure for reliability using Cronbach's alpha. Mothers completing the BMEE were 57% primiparous with 75% vaginal births. The BMEE demonstrated appropriate reliability with a Cronbach's alpha of 0.703 for the summary index and 0.719-0.763 for social support, learning experience and personal experience subscales. The BMEE also indicated good predictive validity; of the six mothers who had a mean score <3 on the 11-item scale post-partum, two (33.3%) were expressing breast milk at 1 month, compared with 37 (80.4%) of the 46 mothers who had a mean score ≥3 on the 11-item scale post-partum (P = 0.012). The BMEE is a promising measure of milk expression experience in this population. Use of this measure may allow improved understanding of women's experiences expressing milk.

Human health effects of trichloroethylene: key findings and scientific issues.

BACKGROUND: In support of the Integrated Risk Information System (IRIS), the U.S. Environmental Protection Agency (EPA) completed a toxicological review of trichloroethylene (TCE) in September 2011, which was the result of an effort spanning > 20 years. OBJECTIVES: We summarized the key findings and scientific issues regarding the human health effects of TCE in the U.S. EPA's toxicological review. METHODS: In this assessment we synthesized and characterized thousands of epidemiologic, experimental animal, and mechanistic studies, and addressed several key scientific issues through modeling of TCE toxicokinetics, meta-analyses of epidemiologic studies, and analyses of mechanistic data. DISCUSSION: Toxicokinetic modeling aided in characterizing the toxicological role of the complex metabolism and multiple metabolites of TCE. Meta-analyses of the epidemiologic data strongly supported the conclusions that TCE causes kidney cancer in humans and that TCE may also cause liver cancer and non-Hodgkin lymphoma. Mechanistic analyses support a key role for mutagenicity in TCE-induced kidney carcinogenicity. Recent evidence from studies in both humans and experimental animals point to the involvement of TCE exposure in autoimmune disease and hypersensitivity. Recent avian and in vitro mechanistic studies provided biological plausibility that TCE plays a role in developmental cardiac toxicity, the subject of substantial debate due to mixed results from epidemiologic and rodent studies. CONCLUSIONS: TCE is carcinogenic to humans by all routes of exposure and poses a potential human health hazard for noncancer toxicity to the central nervous system, kidney, liver, immune system, male reproductive system, and the developing embryo/fetus.

Approaches to advancing quantitative human health risk assessment of environmental chemicals in the post-genomic era.

The contribution of genomics and associated technologies to human health risk assessment for environmental chemicals has focused largely on elucidating mechanisms of toxicity, as discussed in other articles in this issue. However, there is interest in moving beyond hazard characterization to making more direct impacts on quantitative risk assessment (QRA)--i.e., the determination of toxicity values for setting exposure standards and cleanup values. We propose that the evolution of QRA of environmental chemicals in the post-genomic era will involve three, somewhat overlapping phases in which different types of approaches begin to mature. The initial focus (in Phase I) has been and continues to be on "augmentation" of weight of evidence--using genomic and related technologies qualitatively to increase the confidence in and scientific basis of the results of QRA. Efforts aimed towards "integration" of these data with traditional animal-based approaches, in particular quantitative predictors, or surrogates, for the in vivo toxicity data to which they have been anchored are just beginning to be explored now (in Phase II). In parallel, there is a recognized need for "expansion" of the use of established biomarkers of susceptibility or risk of human diseases and disorders for QRA, particularly for addressing the issues of cumulative assessment and population risk. Ultimately (in Phase III), substantial further advances could be realized by the development of novel molecular and pathway-based biomarkers and statistical and in silico models that build on anticipated progress in understanding the pathways of human diseases and disorders. Such efforts would facilitate a gradual "reorientation" of QRA towards approaches that more directly link environmental exposures to human outcomes.

Hematology, plasma chemistry, and bacteriology of wild Tundra Swans (Cygnus columbianus) in Alaska.

Blood and cloacal swabs were collected from 100 (66 female, 34 male) wild Tundra Swans (Cygnus columbianus) molting in northwestern Alaska, USA, 25-28 July 2008, to establish hematologic and serum chemistry reference values and to isolate enteric Salmonella spp. and Escherichia coli O157:H7. Plasma biochemistry and hematology values did not vary significantly by sex or age. Tundra swans had high levels of creatine kinase, lactate dehydrogenase, amylase, and alkaline phosphatase compared with some other avian species (values were up to 7 times greater), possibly indicating capture myopathy. However, concentrations were much lower (up to 8 times lower) than in other waterfowl exposed to similar or more intensive capture methods. White blood cell count and hematocrit values were similar to other waterfowl species, and enteric Salmonella spp. and E. coli O157:H7 were not present among birds sampled. Our data provide the first biochemical, hematologic, and bacteriologic reference values for wild Tundra Swans.

Achievement of personalized pain goal in cancer patients referred to a supportive care clinic at a comprehensive cancer center.

BACKGROUND: Cancer pain initiatives recommend using the personalized pain goal to tailor pain management. This study was conducted to examine the feasibility and stability of personalized pain goal, and how it compares to the clinical pain response criteria. METHODS: Records of 465 consecutive cancer patients seen in consultation at the Supportive Care Clinic were reviewed. Pain relief was assessed as clinical response (≥30% or ≥2 point pain reduction) and personalized pain goal response (pain ≤ personalized pain goal). RESULTS: One hundred fifty-two (34%), 95 (21%), and 163 (37%) patients presented with mild (1-4), moderate (5-6), and severe (7-10) pain, respectively. Median age (59 years), males (52%), and advanced cancer status (84%) did not differ by pain category. Median personalized pain goal at initial clinic consult was 3 (interquartile range, 2-3), was similar across pain groups, and remained unchanged (P = .57) at follow-up (median, 14 days). Clinical response was higher among patients with severe pain (60%) as compared with moderate (40%) and mild pain (33%, P < .001). Personalized pain goal response was higher among patients with mild pain (63%) as compared with moderate (44%) and severe pain (27%, P < .001). By using personalized pain goal response as the gold standard for pain relief, the sensitivity of clinical response was highest (98%) among patients with severe pain, but it had low specificity (54%). In patients with mild pain, clinical response was most specific for pain relief (98%), but had low sensitivity (52%). CONCLUSIONS: Personalized pain goal is a simple patient-reported outcome for pain goals. The majority of patients were capable of stating their desired level for pain relief. The median personalized pain goal was 3, and it was highly stable at follow-up assessment.

Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly.

OBJECTIVE: Breast pumping or hand expression may be recommended when newborns latch or suck poorly. A recent trial found worse outcomes among mothers who used a breast pump in the early postpartum period. The objective of this study was to compare bilateral electric breast pumping to hand expression among mothers of healthy term infants feeding poorly at 12-36 h after birth. DESIGN: Randomised controlled trial. SETTING: Well-baby nursery and postpartum unit. PATIENTS: 68 mothers of newborns 12-36 h old who were latching or sucking poorly were randomly assigned to either 15 min of bilateral electric pumping or 15 min of hand expression. MAIN OUTCOME MEASURES: Milk transfer, maternal pain, breastfeeding confidence and breast milk expression experience (BMEE) immediately after the intervention, and breastfeeding rates at 2 months after birth. RESULTS: The median volume of expressed milk (range) was 0.5 (0-5) ml for hand expressing mothers and 1 (0-40) ml for pumping mothers (p=0.07). Maternal pain, breastfeeding confidence and BMEE did not differ by intervention. At 2 months, mothers assigned to hand expression were more likely to be breastfeeding (96.1%) than mothers assigned to breast pumping (72.7%) (p=0.02). CONCLUSIONS: Hand expression in the early postpartum period appears to improve eventual breastfeeding rates at 2 months after birth compared with breast pumping, but further research is needed to confirm this. However, in circumstances where either pumping or hand expression would be appropriate for healthy term infants 12-36 h old feeding poorly, providers should consider recommending hand expression.